turtle wrote:Thanks for the responses!
Yes, I am worried about her high ALT numbers.
Her Total Bilirubin was 0.3000 with normal range 0.1-0.3 mg/dL, so that number seems to be in the high normal range.
The vet also did a Liver Chemistry test and a Bile Acid test. I will copy the high numbers off of the test papers.
The Liver Chemistry test showed these numbers --
AST at 370, with normal range 25-66 U/L
ALT at 1956, with normal range 12-118
Alk Phosphatase was 567 with normal range 5-131 U/L
GGTP was 22 with normal range 1-12 U/L
The other numbers on that test were in the normal range.
The Bile Acid test showed these numbers –
Bile Acid, Resting (pre meal bile acids) 19.8 with normal range 10.0
Bile Acids, Post (post meal bile acids) 59.5 with normal range 20.0
These tests were done a month ago exactly, we all went on a trip right after this so now I am back home and looking to try to get to the bottom of what is wrong.
An X-ray and ultrasound was recommended and I have a call in to learn more about those and see about having them done. Is one preferred over the other one? I had a rough quote of over $500 for the ultrasound which seems pretty high to me but I have no experience with it.
She has finished the course of antibiotics for the Lyme and she does seem to feel better. I agree that the Lyme is a separate issue and hopefully is cured as much as it can be. Her liver numbers have been high in the past but never this high. But she eats well and does not act sick at all.
Thank you for any help and suggestions!
Misskiwi67 wrote:The ALT is scary high. I recommend advanced testing when the level is around 300-400. The bile acids and bilirubin are not as bad as expected, so liver function is probably acceptable for now. The ALT is a liver enzyme that is released when liver cells are dying, so there is some sort of major trauma going on to your pets liver. Luckily, the liver is one of the organs that can regenerate, which is probably why the function tests are only moderately elevated. Even so, I wouldn't wait to pursue more testing if you are considering it.
The x-ray and ultrasound complement each other, so both are recommended. The x-ray is very good at showing overall size of organs, and gives good quality images of fat, gas, and surrounding tissue. The x-ray will not show lesions within organs or changes to the internal structure of organs, and it is not good at picking up changes in fluid status (such as gallbladder obstruction). The ultrasound is less effective at showing size, and is unable to see through air in the lungs, stomach, intestines etc. The ultrasound is the least expensive non-invasive test that will give you an idea of internal structure of organs .
$500 for an ultrasound and x-rays is decent. I'm in the midwest and radiographs are $135 and ultrasound is $300. Keep in mind that ultrasound requires a LOT of advanced training. This is not something we learn to do in veterinary school, and it takes a lot of time and practice to learn to do it. I'm in the process of learning now. I've got 20 hours of formal classroom training, and it cost me $3,000 to get that training. I am only able to do basic ultrasounds, mostly on an emergency basis only. I'm about 25% of the way through what I expect will be required for me to perform ultrasound on a referral basis. The machine to perform an ultrasound costs anywhere from 20K-100K. The probes alone tend to run 5-10K.
She is on the Denosyl now and from what I have read, it should help her. Would it be better for her to be on Denamarin instead? Or should I just add Milk Thistle to her food?
Thanks for your help!
turtle wrote:My vet wants to do a CBC blood panel to check her liver enzymes to see if anything has changed. I am hoping for lower numbers! She wants me to stay with the Denosyl for now so I will just add some Milk Thistle to her food.
I also talked to the clinic that does the ultra sound, they sound pretty knowlegeable. They quoted $135 for the consultation and $259 for the ultra sound so that is not too bad. My vet wanted to check the numbers then have the ultra sound, and later maybe the x-rays.
So I am hopeful we can find out what is going on with her liver. Thanks again for the replies!
Leslie H wrote:No liver experience, just Lyme's. It tends to have a second flare up 1-2 months after treatment. Not always, just another thing to watch.
Misskiwi67 wrote:It does make sense to recheck the numbers, so this is a good idea, I'm just not expecting much for results as Denosyl is for management of chronic disease, it doesn't treat any underlying disease. Unless the numbers are normal, do the ultrasound. Even if they come down by half (common with Denosyl, its amazing), they are still very high. An ALT over 200 is concerning, anything over 400 requires a full workup.
I would do the x-rays at the same time. The two tests really do complement each other, and we generally will not do ultrasound without them (If there's a giant tumor, why spend $260 on ultrasound?). I'm quite surprised your vet hasn't pushed harder for them, it makes me wonder if they have an older machine and maybe the x-rays should also be done by the specialist.
the Denosyl 425 mg to help her liver function and Marin was also recommended. I was cautioned about using over the counter Milk Thistle because the Marin is formulated for dogs and has just the silymarin, plus many dogs are allergic to the straight Milk Thistle.
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